Brain Tumor Symptoms

Of all the brain tumor symptoms, headache is perhaps the most misleading.

About 70% of people with a brain tumor will at some point in their illness develop a headache.

In almost every case, this headache is associated with other brain tumor symptoms such as epileptic-type seizures, progressive worsening of speech, deteriorating movement, worsening vision or changes in personality.

However, headache as the only AND persisting symptom of a brain tumor is not that common at all.

Surveys would suggest that ONLY 2% of people diagnosed with brain tumor will have a headache and headache alone before they are diagnosed with a brain tumor.

To put this into some sort of perspective, consider the following:

• About 140 people out of every 1,000,000 will get a brain tumor each year
• About 600,000 people out of 1,000,000 will get a headache each year
• Of the 140/1,000,000 with brain tumour symptoms, only 2% will have headache, and headache alone before the tumor is detected on a brain scan
• This means that ONLY 3 people out of a million each year will have a headache exclusively due to a brain tumor
• Compare this to the 600,000 who get other headaches
• In a given year the risk that a headache is a brain tumor symptom (without other progressive symptoms of weakness, speech loss, visual loss, or personality change) is about 3/600,000 or 0.0005%

What is a typical brain tumor headache?

In summary, almost any sort of headache can be associated with any brain tumor.

The classic brain tumor headache is that of raised intracranial pressure. The headache is described as a moderate pain present first thing in the morning on wakening, easing as the morning passes.

Spontaneous vomiting may occur on moving from lying to standing. This is actually quite rare - maybe only 17% will vomit in the morning with a real brain tumor headache. (By far and away the most common cause of a headache and vomiting is a migraine!)

The majority of headaches associated with brain tumors are indistinguishable from tension-type headache (77% in one series of brain tumor headache cases).

I have known a case in which my patient described a typical tension-type headache. Due to the man's age and previous history of cancer I organised a brain scan which did in fact demonstrate (regrettably) a new brain tumor which had spread from his original lung cancer.

It is not the type of headache that is important, it is the context.

An older person with previous cancer, for example, will nearly always need a CT Brain scan if a new headache develops, as I proved in the case above.

What else could mimic a "classic" brain tumor headache?

Remember than brain tissue (the actual cortex and neuones of the brain substance) do not have pain fibres.

Pain-sensitive structures include

• The meninges
• The venous sinuses
• The cerebral arteries

The following could easily mimic a brain tumor headache (and I have encountered all of these):

1. Idiopathic Intracranial Hypertension - 94% will have severe headache
2. Chronic Subdural Haematoma - 81% experience headache
3. Brain Abscess - 80% will have significant headache, but there are often other symptoms like seizures for example
4. Carbon dioxide retention, from neuromuscular failure - can cause a headache on wakening that sounds like a brain tumor. There will be a known history of muscle weakness such muscular dystrophy or motor neurone disease

For some reason cerebral metastases (which spread from cancer in other organs such as lung or breast) seem to be likely to produce headache than primary brain tumours.

Does every headache need a brain scan?

The vast majority of simple headaches are just that - simple headache like tension-type or migraine.

A combination of lifestyle and targeted medication is all that is needed, not scans.

When there is a real risk that you are dealing with a brain tumor headache, brain scans are required.

The following factors may increase the risk of a serious cause:

1. New onset headache aged >50 years
2. Previous history of cancer
3. Pulsatile noise associated with headache (pulsatile tinnitus)
4. Abnormal neurological examination
5. Presence of papilloedema when the back of the eye is examined with an ophthalmoscope

None of these features is 100% predictive, but if present they should push towards further assessment.

It should be remembered that other conditions can brain tumor symptoms - as outlined above.

Brain Tumor Symptoms - References

Suwanwela N et al. Headache in Brain Tumor: A Cross-Sectional StudyHeadache: The Journal of Head and Face Pain 1994;34:435-8(Free Abstract only)

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